Preoperative Clinical Phenotyping for Individualised Rehabilitation in End-Stage Knee Osteoarthritis

Background: Osteoarthritis (OA) of the knee is a highly prevalent and heterogeneous condition. Identifying distinct clinical phenotypes within end-stage knee OA populations may inform tailored preoperative management strategies for individuals awaiting total knee replacement (TKR) surgery. Methods: This cross-sectional study employed exploratory factor analysis to identify clinical presentation patterns among patients with knee OA awaiting TKR in South Africa, using modifiable variables including demographic data, physical examination findings, patient-reported outcomes, and functional measures. Results: Three distinct clinical phenotypes emerged: (1) gait and weight-characterised by poor gait mechanics, obesity, and low self-efficacy; (2) central pain-encompassing central sensitisation, depression, and reduced functional performance; and (3) functional factors-reflecting muscular weakness and functional limitations. Conclusions: This study highlights the heterogeneity in clinical presentations among patients with end-stage knee OA awaiting TKR in South Africa. The identified phenotypes suggest a need for tailored, multidisciplinary preoperative interventions incorporating weight management, pain management, psychological support, targeted exercise programs, and behavioural change strategies to optimise post-surgical outcomes and enhance overall care.